Providing Care for Persons with Dementia in Rural Communities: Informal Caregivers’ Perceptions of Supports and Services

Dementia is one of the costliest and most time-consuming diseases among older persons. Although informal caregivers provide the majority of care for persons with dementia, little is known about the self-perceived need for social services of caregivers of persons with dementia within rural areas. This pilot study examined the knowledge, access and intent of the practice-oriented service model of caregivers of persons with dementia in rural communities in the Midwest U.S. After a systematic training, researchers interviewed 11 rural caregivers of persons with dementia (n = 11). Data were analyzed using thematic analysis. Although similarities with other caregivers of persons with dementia were found, important differences suggesting unique issues among these rural caregivers of persons with dementia. Many participants found strength in their community, which often served as a safety net of support. Consistent with existing literature, participants expressed financial concerns, geographic barriers and lack of dementia-specific services when using formal services. The need for more specialized formal services in rural areas to supplement existing informal care networks is discussed. Policies and services based on rural caregivers’ unique concerns and challenges and that build upon their existing care networks are recommended.     

A Comparative Study of Two Groups of Sex Offenders Identified as High and Low Risk on the Static-99

The purpose of this study was to identify possible differences between high- and low-risk sex offenders. The subjects included 285 sex offenders on probation. They were evaluated with the Static-99, Abel Assessment, Raven's, and MMPI-2. A criminal history review identified the number of prior offenses and the age/sex category in the index offense. The high- and low-risk groups were compared on 26 variables: intelligence, age, criminal history, denial patterns, measured sexual interest in children, admission of sexual interests, a childhood history of sexual abuse, victim's age, and personality variables. Four variables significantly accounted for 64% of the variance: age, prior number of felonies, the Cognitive Distortion Score, and the MMPI-2 Infrequency scale score.     

Maternal Disrupted Communication During Face‐to‐Face Interaction at 4 months: Relation to Maternal and Infant Cortisol Among at‐Risk Families

The study evaluated the association between maternal disrupted communication and the reactivity and regulation of the psychobiology of the stress response in infancy. Mothers and infants were recruited via the National Health Service from the 20% most economically impoverished data zones in a suburban region of Scotland. Mothers (N = 63; M age = 25.9) and their 4‐month‐old infants (35 boys, 28 girls) were videotaped interacting for 8 min, including a still‐face procedure as a stress inducer and a 5‐min coded recovery period. Saliva samples were collected from the dyads prior to, during, and after the still‐face procedure and later assayed for cortisol. Level of disruption in maternal communication with the infant was coded from the 5‐min videotaped interaction during the recovery period which followed the still‐face procedure. Severely disrupted maternal communication was associated with lower levels of maternal cortisol and a greater divergence between mothers' and infants' cortisol levels. Results point to low maternal cortisol as a possible mechanism contributing to the mother's difficulty in sensitively attuning to her infant's cues, which in turn has implications for the infant's reactivity to and recovery from a mild stressor in early infancy.     

Forensic psychiatric nursing. Discursive practices and the emergence of a specialty

1. While some authors argue that specialization is a threat to holistic nursing practice, others suggest that specialization is not only desirable and inevitable but should follow a rigorous process, including specific educational curriculum and examination procedures. 2. Two opposing views regarding forensic nursing are found in contemporary nursing literature. Some authors resist the discourse of specialization in nursing, while the discursive practices of others (e.g., leaders in forensic psychiatric nursing) could reflect a desire for power. 3. Using a poststructuralist approach, the controversy that has accompanied the development of forensic nursing through discursive practices is analyzed.     

Declining immunity with age in the wild

Despite their higher metabolic rates and lifetime energy expenditures, birds generally outlive similar-sized mammals even in the wild, often reaching maturity and aging considerably more slowly. Wild populations of many bird species have been monitored for years using banding-and-recapture methods, allowing field ornithologists to document age-related declines in survival and reproductive success. Although elderly birds rarely reach advanced stages of senescence in nature, many show other signs of physiological deterioration. In this Perspective, we review recent reports of aging-related changes in the immune response of two small European songbirds, the barn swallow and the collared flycatcher. Researchers in both studies challenged birds' humoral immune response by administering antigen to free-ranging adults during the breeding season. Older barn swallows--particularly breeding females--showed lower antibody responses (both primary and secondary) to vaccination with Newcastle disease virus, an avian pathogen. In flycatchers, older females raised lower antibody titers than younger breeders did in response to an injection of sheep red blood cells, a nonpathogenic antigen, and produced offspring with lower average body masses. Although the relevance of such measures of "immunosenescence" to actual fitness, reproductive success, and mortality is still unclear, studies of wild vertebrate populations may ultimately provide an important link between laboratory research and our understanding of the natural history and evolution of basic mechanisms of aging.     

Is postmenopausal life-span a gift of modern health or a product of natural selection?

The author discusses how researchers from various scientific disciplines view the origins of and mechanisms (evolutionary as well as physiological) underlying menopause in humans. She describes presentations from a symposium centered around interdisciplinary perspectives on female reproductive aging. Comparative zoology, primatology, and anthropology have much to contribute to our understanding of human menopause; hence the symposium contained speakers representing these subdisciplines, as well as the more typical disciplines of endocrinology and neurobiology.     

The Effects of Organizational Culture, Structure and Market Expectations on Technological Innovation: A Hypothesis

This paper is chiefly concerned with the causes and technological effects of ‘short-term pressures’ on and in large firms in British manufacturing. ‘Short-term pressures’ (STP) are defined as factors acting upon (or within) an organization which tend to cause decision-makers (explicitly or implicitly): (a) to raise their time rate of discount; and/or (b) to foreshorten the time horizon beyond which future revenues are ignored altogether. Such pressures will tend to reduce the rate of investment (defined very broadly as present sacrifice of cash flow for future gain), and/or bias it towards ‘short-term’ projects. In the British context such pressures upon firms arise from the nature of the relationship with shareholders. (High interest rates and low profitability have similar effects but should be analysed separately.) STP can also be generated and/or transmitted within organizations. STP acting within an organization are likely to be associated with pressures on middle and lower management to take a narrow, ‘sectional’ view, avoiding efforts and expenditures whose benefits may go largely to other parts of the firm. The first section sets out a theoretical framework within which to predict the intensity of external STP, and uses this to assess their likely incidence. After defining and discussing the concept of culture in organizations, it is argued that culture dominates structure at higher levels, and the reverse at lower levels. The second section deals with internal STP, and shows how performance pressures on managers at various levels are determined by the interaction of structural and cultural factors. Structural factors considered include organizational configurations and methods of auditing and management accounting. Internal performance pressures may at various levels be quite different from the external pressures. The third section shows how, by contrast with economic rationality, STP may affect technological progress - distinguishing between process change, which under certain circumstances may actually be stimulated, and product change, which is likely to be seriously inhibited. (It is pointed out that the impact of any set of performance pressures must be evaluated by comparison with an alternative set, which may themselves not be ideal.) At each stage the analysis is differentiated to allow for the differing circumstances of the UK electronics, Pharmaceuticals and mechanical engineering industries, building up a hypothesis as to the differing incidence of STP among them. This hypothesis can account for the very different record of these UK industries in innovation.     

Rationalising knowledge: IT systems, professional identities and power

This paper explores the impact of a new IT system on the knowledge claims and occupational boundaries made by professional groups within a hospital laboratory setting. Within organizational settings professional groups enjoy considerable power and status through the specialised knowledge claims they make, deploying a variety of material and discursive resources to secure these. However, when organizations introduce new technologies to manage information needs, professional boundaries and claims to expertise may be threatened. This paper examines the strategies deployed by two key professional groups – Medical Laboratory Scientific Officers and medics – to secure their knowledge claims and statuses within the new organizational context shaped in part by an IT system. Though medics were more successful here, they had to accommodate to new demands within the organization. The professional identity and organizational space of the MLSOs were also redefined but, in contrast, by being narrowed. The different experiences and strategies of the two groups reflect their unequal holding of cultural capital and their differential capacity to define their status relative to the organization itself.     

Gray codes for randomization procedures

We introduce a simple combinatorial scheme for systematically running through a complete enumeration of sample reuse procedures such as the bootstrap, Hartigan's subsets, and various permutation tests. The scheme is based on Gray codes which give tours through various spaces, changing only one or two points at a time. We use updating algorithms to avoid recomputing statistics and achieve substantial speedups. Several practical examples and computer codes are given.